CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Uva Health Culpeper Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $45,184
Cash Discount Price: $60,084
vs. Medicare Baseline: 1.92x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Uva Health Culpeper Medical Center is $45,184. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60,084. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.92x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$60,084

Average discount available for prompt cash payment at this facility.

Insurance Median

$45,184

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$23,503.93

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $23,503.93 (100%)

Cash / Self-Pay: $60,084 (256%)

Insurance Median: $45,184 (192%)

Cash: $60,084 (256% of Medicare)

Ins. Median: $45,184 (192% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $23,503.93 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Commonwealth Attorney [99931]	$2,604	11%
Tdo [99908]	$2,604	11%
Blue Ridge Pace [10510]	$23,691	101%
Medicaid / KanCare	$23,691	101%
Blue Cross Blue Shield	$23,728 - $100,169	101%
Cigna	$23,728 - $83,422	101%
Medicare (plans)	$23,728 - $26,324	101%
UnitedHealthcare	$23,728 - $100,169	101%
VA Ccn [99926]	$23,728 - $36,108	101%
VA Ccn [99927]	$23,728 - $36,108	101%
Veterans Administration [99910]	$23,728	101%
Aetna	$23,966 - $73,004	102%
Humana	$24,203 - $26,324	103%
Veterans [99909]	$25,008	106%
HMO Part B [10099]	$26,324	112%
Carefirst [30007]	$43,643 - $48,479	186%
Geha [40009]	$50,207 - $65,167	214%
Sentara [40021]	$65,293 - $73,243	278%
Sentara Behavioral Health [40052]	$73,243	312%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $60,084.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 451.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Uva Health Culpeper Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 451.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.